Neonatology Book

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Meconium Aspiration Syndrome

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  1. Epidemiology
    1. Prevalence
      1. Occurs in up to 15% of cases in which amniotic fluid is meconium-stained
      2. Occurs in as many as 1-2% of all deliveries
  2. Pathophysiology
    1. Meconium contains gastrointestinal fluids which cause localized inflammation
    2. Meconium aspiration results in severe airway inflammation and Pneumonia risk
    3. Meconium aspiration occurs in utero, not at delivery
  3. Signs
    1. Hypoxia
  4. Differential Diagnosis
    1. See Newborn Respiratory Distress
  5. Imaging: Chest XRay
    1. Patchy Atelectasis
    2. Lung consolidation changes
  6. Management: Meconium stained infant
    1. See Respiratory Distress in the Newborn
    2. See Newborn Resuscitation
    3. Infant brought to warmer with head angled down and with minimal stimulation
    4. Evaluate infant for vigorous activity
      1. Vigorous infants without distress may be managed routinely
      2. Infants with Heart Rate <100 beats/min, apnea, or poor tone require intervention
        1. Intubation
        2. Suctioning
  7. Prevention
    1. Suctioning head at the perineum no longer recommended
      1. See pathophysiology above regarding in utero aspiration
      2. Vain (2004) Lancet 364:597
    2. Amnioinfusion does not decrease meconium aspiration risk

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